06:27pm Sunday 19 January 2020

U-M expert highlights implications of new study on young-onset dementia in JAMA article

ANN ARBOR, Mich. —  A University of Michigan expert says a new study by Swedish researchers opens the door to better understanding early predictors of developing dementia before age 65 while raising new questions about risks tied to the devastating memory disorder.
Commentary “Young-Onset Dementia, Unanswered Questions and Unmet Needs” by Deborah Levine, M.D., M.P.H., assistant professor of medicine in the division of general medicine in the U-M Medical School, appears in the Journal of the American Medical Association (JAMA) Internal Medicine. The piece corresponds with a study led by Peter Nordstrom, Ph.D., of Umea University in Sweden. Nordstrom’s study identified risk factors in late adolescence that predicted dementia before age 65 (characterized as young-onset dementia or YOD) among Swedish men in mandatory military service.  

One of the most significant findings by Nordstrom and colleagues, Levine says, is that high blood pressure in late adolescence increased the likelihood of developing dementia in middle age. Even after accounting for whether an individual had a stroke, high blood pressure still was associated with a higher risk of developing YOD.

“The finding that high systolic blood pressure in late adolescence is associated with an increased risk of young-onset dementia, if confirmed, provides a potential target for intervention studies to prevent young-onset dementia and possibly late-onset dementia,” says Levine, also a research scientist with the Center for Clinical Management Research, VA Ann Arbor Healthcare System and assistant professor of medicine in the departments of internal medicine and neurology at U-M.

Levine cautions that the observational study by Nordstrom was unable to prove that having a risk factor, like high blood pressure, causes YOD or that treating a risk factor will prevent YOD.
Still, these are potential implications of the study.

“Rather than being unavoidable, young-onset dementia may be preventable,” Levine says, “In addition to avoiding head trauma, drug and alcohol intoxication, the study by Nordstrom and colleagues raises the possibility that detecting and treating high blood pressure in adolescents and young adults may prevent young-onset dementia and perhaps late-onset dementia.”

The study is especially timely, Levine says, as more Americans may develop YOD because of increases in traumatic brain injury among young veterans and stroke among young African Americans and middle-aged adults.

Unfortunately, Levine says, many patients and families experiencing YOD have unmet needs.

 “Young-onset dementia causes major health, social, and financial problems for patients and their families,” she says. “Adults with young-onset dementia often become unable to parent young children or hold a job. They frequently lose health insurance. Although adults with young-onset dementia have high caregiving needs, many lack access to health care and adult caregivers.”

“One priority is to do research that identifies ways to prevent young onset-dementia. Treating high blood pressure in adolescents and young adults may be one way to prevent young-onset dementia,” Levine adds. “Another priority is to improve care and access to long-term services for adults with young-onset dementia. This is urgent because adults with young-onset dementia and their families really need our help.”

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